Study: Diabetes affects patients' well-being and also impacts spouses

WEST LAFAYETTE, Ind. - Older patients with diabetes who are not dealing well with the disease are likely to have symptoms of depression, and spouses of older patients also suffer distress related to diabetes and its management, according to research from Purdue University.

"Responsibilities and anxieties can differ for patients with diabetes and their spouses, but each may experience stress, frustration and sadness at times related to the demands of living with this disease," said Melissa M. Franks, an assistant professor of child development and family studies. "We know spouses often support their partners, but in our work we want to know what form their involvement takes and how the disease and its management affect both the patient and spouse."

Franks and her team found that the distress spouses feel is similar to what patients feel, and this could contribute to their own depressive symptoms such as irritability or sadness. These depressive symptoms come from their own anxieties about living with the disease or caring for someone with the disease and not necessarily because the other person is struggling.

Researchers also found that when male patients were concerned about the management of their diabetes, their depressive symptoms were elevated more than those for female patients with similar levels of concerns.

"This gender difference is consistent with prior work showing that male patients who are not managing their disease well tend to experience greater depressive symptoms," Franks said. "And while we saw this difference between male and female patients, we did not see the same pattern of distress between their respective spouses. This is surprising, because one might assume that the spouse would be as worried, or, according to family roles, that wives might worry more. However, more research, especially long-term observations, is needed."

The findings, based on statistical models with 185 couples older than 50, appeared in the December issue of the Family Relations journal. The patients and spouses completed individual surveys that measured distress related to diabetes, such as adherence to treatment recommendations, as well as depressive symptoms. The gender effects were measured by comparing the couples' responses. There were 67 female patients and 118 male patients, and each couple was screened to make sure only one person had diabetes.

"Because spouses' distress is not always directly linked to feelings of their partner, it tells us that we need to pay more attention to the spouse as well as the patient," she said. "Understanding the triggers for depressive symptoms can help practitioners and experts better care for patients and spouses as individuals and as a unit.

"We also found that many people reported some depressive symptoms, and some reported levels indicative of risk for clinical depression. It's important to consider depressive symptoms because they may signal concerns and problems that could be alleviated with treatment."

Diabetes affects about one in five Americans over the age of 60, and the majority of those people have Type 2 diabetes, which is a disease of the endocrine system. Type 2 diabetes, also referred to as adult-onset diabetes, is caused by insufficient secretion of insulin and resistance to insulin, which is problematic because it lessens the ability of cells to absorb glucose from the bloodstream. The incidence of the disease, which is considered a leading cause of death, is increasing as more people are overweight and sedentary.

The disease is managed daily through diet, exercise and medications. Complications, such as poor blood circulation, vision impairment, heart disease and stroke, are possible if the disease is not managed. In this study, spouses often reported that the disease's daily management as well as the fear of their loved one's living with diabetes were common concerns.

Franks co-authored the study with Todd Lucas from Wayne State University, Mary Ann Parris Stephens from Kent State University, Karen S. Rook from the University of California at Irvine and Richard Gonzalez at University of Michigan.

This work was funded by the National Institute on Aging and the Kent State University-Summa Health System Center for the Treatment and Study of Traumatic Stress. Franks' future studies will look at diet management in the context of distress and depression for patients and their spouses.

In this dyadic study, we examined diabetes distress experienced by male and female patients and their spouses (N = 185 couples), and its association with depressive symptoms using the Actor-Partner Interdependence Model. Diabetes-related distress reported by both patients and spouses were associated with each partner's own depressive symptoms (actor effects) but generally was not associated with the other's depressive symptoms (partner effects). Moreover, diabetes distress was associated with depressive symptoms more strongly for male than for female patients, but this association did not differ between female and male spouses. Findings underscore the dyadic nature of managing chronic illness in that disease-related distress was experienced by patients and by their spouses and consistently was associated with poorer affective well-being.